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Updated: Aug 15, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
[Results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant
J Kordelle1, L Frommelt, D Klüber
1Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Objective:
Are the results of one-stage exchange arthroplasties to treat periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) comparable to bacteriologically unselected studies of one-stage exchange operations?
Method:
From 1996 to 1997 twenty patients with a periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated at the ENDO-Klinik by an one-stage exchange arthroplasty. Mean follow-up of fifteen one-stage exchange total hip replacements and 5 one-stage exchange total knee replacements was 16 months. The patients were examined by means of clinical, laboratory-chemical and radiological tests. In addition, postoperative joint aspiration was performed on 14 patients.
Results:
In 11 cases (61%) the periprosthetic infection was treated successfully with only one one-stage exchange operation. In cases with persisting infection the period between the first exchange arthroplasty and the repeated clinical manifestation of the infection (second exchange operation) was 2 months on average. 93% of the joint aspirations (n = 14), performed on average 4 weeks postoperatively, correlated with the result of the follow-up tests.
Conclusion:
Periprosthetic infection with MRSA is a problematic infection. Because of the reduced therapeutic possibilities it is associated with a higher rate of recurrence than the unselected group of patients as a whole [6, 11, 16, 17, 19, 20]. The authors recommend one-stage exchange arthroplasty using a combination of vancomycin and ofloxacin as admixture to polymethylmethacrylat (Refobacin Palacos R). This procedure does, however, need further development. Intraoperative use of an antiseptic and systemic administration of rifampicin, as recommended by Zimmerli [23] is a further possibility.
Insights
One-stage exchange arthroplasty is a viable treatment for periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA). While recurrence rates are higher than in unselected cases, this approach offers a potential solution for challenging MRSA infections.
Area of Science:
- Orthopedic surgery
- Infectious disease management
- Biomaterials in medicine
Context:
- Periprosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a difficult-to-treat pathogen in PJIs.
- One-stage exchange arthroplasty is an alternative surgical strategy for PJI management.
Purpose:
- To evaluate the efficacy of one-stage exchange arthroplasty for treating MRSA periprosthetic joint infections.
- To compare the outcomes of MRSA PJI treatment with one-stage exchange to general PJI treatment outcomes.
- To assess the success rate and recurrence patterns of this specific treatment approach.
Summary:
- Twenty patients with MRSA PJI underwent one-stage exchange arthroplasty (15 hip, 5 knee).
- The overall success rate was 61% after a single procedure, with a mean follow-up of 16 months.
- Postoperative joint aspirations showed high correlation with clinical outcomes, aiding in infection assessment.
Impact:
- One-stage exchange arthroplasty demonstrates potential for MRSA PJI treatment, though with a notable recurrence rate.
- The study suggests specific antibiotic combinations (vancomycin/ofloxacin) for polymethylmethacrylate cement.
- Further research and procedural refinement are recommended for optimizing outcomes in challenging MRSA PJI cases.
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